Colorado Division Independent Medical Examination physicians must write their report on this template, and every topic is required. It runs from the scope of the exam and injury history through records review, examination, testing, psychological evaluation and diagnosis to the MMI date, the impairment rating under the AMA Guides Third Edition (Revised), the rationale, work restrictions, maintenance care and a signed attestation.
The DIME physician, who is Level II accredited, completes all sections A through O and signs the attestation.
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Division Independent Medical Examination (DIME) Report Template
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Yes. The template states that it is to be used when writing DIME reports and that all topics are required. Reports with errors or missing topics get an Incomplete notice from the DIME Unit and must be revised and resubmitted to all parties and the Unit at the same time.
Section K matches each work-related diagnosis to the AMA Guides, Third Edition (Revised), states the pages and tables used, includes all worksheets, rates at extremity and whole person level, and covers every body part on the DIME application. If apportioning, give the prior rating and attach the calculation worksheet.
No. The DIME Physician Quick Reference Guide says time spent revising a report after an Incomplete notice is not billable. Billable time runs from physician confirmation until the report is submitted, in 15-minute increments, and Section O records total minutes.